Targeted exhaled breath analysis for detection of Pseudomonas aeruginosa in cystic fibrosis patients

Objectives: In cystic fibrosis (CF), Pseudomonas aeruginosa (PA) is an important respiratory pathogen. Routine microbial surveillance is time-consuming and requires expectorated sputum. Volatile organic compounds (VOCs) in exhaled breath may be indicative of PA colonization. We aimed to 1) identify VOCs associated with PA in literature and 2) perform targeted exhaled breath analysis to recognize PA positive CF patients non-invasively. Methods: This study consisted of 1) a literature review for VOC targeting, and 2) a cross-sectional CF-study. Definitions used: A) PA positive, PA culture at visit/chronically; B) PA free, no PA culture in ≥12 months. Exhaled VOCs were identified via quadrupole MS. The primary endpoint was the area under the receiver operating characteristics curve (AUROCC) of individual VOCs and VOCs combined in a multi-variate regression model. Results: 241 VOCs were identified in literature of which 56 were further evaluated and 13 could be detected in exhaled breath. Exhaled breath of 25 pediatric and 28 adult CF patients, PA positive (n=16) and free (n=28) was available. 3 VOCs were significantly different (p Conclusion: Targeted VOC analysis based on published data appears to discriminate children with and without PA culture, composite VOC fingerprints appear to discriminate adults. These data merit further validation of breath analysis as alternative for pathogen detection. This work is supported by the Institut Merieux and the UK CF Trust.